Paying For a Prosthetic Eye: What Does Insurance Cover? By M.D. Beck At Isnare.com Ezine Articles

Most insurance plans will pay at least part of the cost for a prosthetic eye. How much of the cost is covered will depend on several factors, including how the person's natural eye was damaged, whether there is any expectation of restoring any degree of sight to the eye, if the person can see anything with that eye or if he is totally blind in it, and who does the work for the artificial eye. There are some insurance companies that try to avoid paying, but most doctors who work with artificial eyes know what to do in order to get the patient's claim paid.

It's often unreasonable to assume that a person who has insurance should have to pay the entire cost of his prosthetic eye, but someone without insurance will have to pay that entire bill, and it can be costly – usually between $1800 and $2500 for most patients. Fortunately, both private insurance companies and government-offered insurance will pay for a prosthetic eye up to a specific amount, so people who have any kind of insurance will have at least part of their artificial eye paid for, although they may have some out-of-pocket costs associated with it, as well.

When a person goes to a doctor – a maxillofacial surgeon, an ocularist, or another doctor who handles prosthetic eyes – the initial consultation is usually free, so whether that person has insurance won't be an issue at that time. There are also two different kinds of artificial eyes that can be purchased – 'stock' eyes that are mass-produced and aren't designed to fit any specific patient, and 'custom' eyes that are created to fit only one person and won't fit anyone else.

The custom artificial eyes are more costly and can take longer to get, although there are some providers that offer same day service for custom hand painted prosthetic eyes. Custom artificial eyes have to be created through taking an impression of the person's eye socket and using that to make an eye that will exactly fit that person's facial structure. The stock eyes can be used for people who have less money or no insurance, since they don't cost as much. They are adjusted to fit a particular patient as well as possible, but they may never fit as comfortably as a custom artificial eye.

A doctor with strong abilities and skills when it comes to fitting the eye to the patient can make stock eyes fit reasonably well and help people who can't afford that much have a good-quality prosthesis that will be comfortable, look right, and last a long time with proper care and maintenance. Even custom eyes require some adjustment and fitting to get them just right, so that little bit of work during the fitting of the prosthetic eye is to be expected.

Any artificial eye should be replaced every three to five years for proper hygiene, and insurance companies are aware of that. These prosthetics don't last forever and there are provisions in most insurance policies to allow people who have artificial eyes and other types of prosthetics to get them replaced on schedule.

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